Provider Demographics
NPI:1427259225
Name:PHENIXFOOTCARE
Entity type:Organization
Organization Name:PHENIXFOOTCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NDEM
Authorized Official - Middle Name:U
Authorized Official - Last Name:NDEM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-298-0022
Mailing Address - Street 1:1810 STADIUM DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-3100
Mailing Address - Country:US
Mailing Address - Phone:334-298-0019
Mailing Address - Fax:
Practice Address - Street 1:1810 STADIUM DR
Practice Address - Street 2:SUITE 120
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3100
Practice Address - Country:US
Practice Address - Phone:334-298-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty